Will Viagra Make Me Better In Bed?

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There are some concerns or uncertainties about sexual performance, that couples experience from time to time. These are either related to their own insecurities, fears or physical dysfunctions that can be transitory or persistent.
Erectile dysfunction is the inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance and affects a considerable proportion of men at least occasionally.

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What causes erectile dysfunction?

Age alone is not a risk factor for ED, but underlying health issues such as diabetes, high blood pressure, obesity, high cholesterol, chronic alcohol or drug abuse, certain medications, and injuries can lead to impotence. Any condition that may restrict blood flow to veins over time, like smoking, can lead to ED.
Diabetes mellitus (DM) is the single most common cause of erectile dysfunction (ED) seen in clinical practice.
Medical conditions like Parkinson’s disease or Peyronie’s disease (scar tissue build-up in the penis) may cause erectile dysfunction. Mental health issues can take their toll, too–depression or stress can result in loss of libido. Erection failures may occur repeatedly in men who experience performance anxiety due to erectile dysfunction.
Many medications have impotence or sexual dysfunction listed as a side effect. A medication review should be performed by a healthcare provider to determine if any prescription drug treatment may be contributing to symptoms. Medications such as antidepressants, blood pressure drugs, certain antihistamines, antipsychotics, drugs used for benign prostatic hypertrophy (BPH), and anti-HIV drugs may lead to erectile dysfunction.

 

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Fast facts on erectile dysfunction:

  • Causes are usually medical but can also be psychological;
  • Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis;
  • Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.

Current treatments are aimed to provide temporary symptomatic relief but do not interfere with the progress of the disease itself.
The first-line treatment for ED is the class of phosphodiesterase type 5 (PDE5) inhibitors. PDE5 is a substance produced in the lungs and other parts of the body that breaks down another substance called cyclic guanosine monophosphate (GMP). Cyclic GMP causes the blood vessels (arteries) to relax and widen. These inhibitors enhance nitric oxide (NO)-mediated vasodilation in the corpus cavernosum by inhibiting cyclic guanosine monophosphate breakdown.
Current data collected from various clinical trials strongly support the efficacy, tolerability, and overall safety of PDE5Is for the treatment of ED. PDE5Is should still be considered first-line therapy for the treatment of most aetiologies of ED.
These drugs are safe for healthy hearts, but all men with cardiovascular disease should take special precautions, and some cannot use them under any circumstances.
Sildenafil (Viagra) is the most effective oral therapy currently available for erectile dysfunction.
“Originally, we were testing sildenafil, the active drug in Viagra, as a cardiovascular drug and for its ability to lower blood pressure,” Dr. Brian Klee, senior medical director at Pfizer, told French news agency, AFP. “But one thing that was found during those trials is that people didn’t want to give the medication back because of the side effect of having erections that were harder, firmer and lasted longer.”
In the first decade (1998-2008) after its approval, Viagra revolutionized the sex lives of millions and became one of the most commercially successful drugs in the world, with over 1.8 billion pills used by about 35 million people. The number is still growing.

 

Is Viagra dangerous for patients with heart disease?

Sexual dysfunction in men after the diagnosis of coronary artery disease or a myocardial infarction is common. This can be related mostly d to the fear that the exertion of sexual activity will precipitate another myocardial infarction, but 10 to 15% of erectile dysfunction is due to organic causes. All patients taking either sildenafil or nitrates must be warned of the contraindications and potential consequences of taking sildenafil within 24-hour interval after taking a nitrate preparation, including sublingual nitroglycerin.
Numerous theoretical evidence supports the use of PDE5 inhibitors in HF patients, and clinical trials have begun exploring their potential as an adjunct in the pharmacological management of patients with heart failure.
However, mixed results have been reported, possibly because of sample heterogeneity or methodological inconsistencies.

The problem for cardiac patients

The problem of Viagra in cardiac patients is the effect on arteries. All arteries, not just those in the penis, generate nitric oxide, so any artery can widen in response to Viagra, causing blood pressure to drop temporarily by 5-8 mmHg, even in healthy men.
Nitrates are drugs that create an additional supply of nitric oxide, and thus are widening the arteries. That’s how they open the partially blocked coronary arteries in patients with angina. But because nitrates and ED pills both act on nitric oxide, the drugs don’t mix.

  • Viagra cannot be administrated with nitric oxide donors or nitrated in any form (Nitroglycerin Isosorbide, Nitroprusside, Amyl nitrite or amyl nitrate). Nitrate esters are commonly used in the treatment of angina pectoris, or “chest pain”, myocardial infarction, and congestive heart failure. The combination of nitrates and Viagra can lead to a dangerous fall in your blood pressure.
  • Also, do not take nitrate-containing medicines up to 24 hours after you take Viagra.
  • If you are not certain, it is better to ask the doctor or the pharmacist.

Caution is to be used in patients who have suffered heart attacks, strokes, or serious disturbances of the heart’s pumping rhythm in the previous six months, in men with a history of congestive heart failure or unstable angina, and in men with low blood pressure or uncontrolled high blood pressure (above 170/110 mm Hg).
Because certain medications can boost the blood levels of these drugs, men taking erythromycin or certain antifungal, or anti-HIV medications should use only low-dose Viagra (25 mg). Reduced dosage is also important for men with advanced age and for those with significant kidney or liver disease.

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How to take Viagra

Do not take Viagra from unknown sources. Buy Viagra from the pharmacy. There is a high rate of Viagra counterfeit reported. Different sites sell different Viagra. Search for authentic sites selling authentic Viagra.
Also, you should not use Viagra with any other local or oral treatments for erectile dysfunction.
Viagra takes longer to start working if you take it with a heavy meal.
Also, drinking alcohol can temporarily impair your ability to get an erection.
We are advising not to drink excessive amounts of alcohol if you desire an immediate and efficient effect from Viagra.
You should not take Viagra more than once a day.
You should take Viagra about one hour before you are planning to have sex. Swallow the tablet whole with a glass of water.

Is Viagra safe?

Yes, Viagra is generally well tolerated. Safety was proven in a number of clinical studies. Sildenafil was administered to more than 9500 patients aged 18-87.
The most frequent side effects are:

  • Nosebleeds
  • Headaches
  • Upset stomach and heartburn
  • Flushing of the skin
  • Difficulty sleeping
  • Worsening shortness of breath
  • Nasal congestion.

Other side effects include:

  • Fluid retention
  • Nausea and diarrhoea
  • Pain in the extremity (arm or leg)
  • Temporary muscle aches
  • Fever
  • Numbness

A prolonged erection (greater than four hours) in a male patient is a rare but very serious side effect; if this should happen to you, you should go to an emergency room or contact your doctor immediately.

  • Sudden loss of vision in one or both eyes has occurred in patients on PDE5 inhibitors. Such an event may represent serious dysfunction of the optic nerve and requires immediate medical attention.
  • Sudden loss of hearing may occur and may be accompanied by dizziness and/or ear ringing. Patients should seek prompt medical attention should this occur.

Despite this, remember that it is a medicine released by prescription.
The safety of Viagra has not been studied and therefore is contraindicated in the following groups: patients with severe hepatic impairment, patients with hypotension (blood pressure <90/50 mmHg), a recent history of stroke and known hereditary degenerative retinal disorders such as retinitis pigmentosa.
The most common adverse reactions include a headache, flushing, dyspepsia, nasal congestion, dizziness, nausea and altered vision.
As dizziness was reported in clinical trials, it is better not to drive or to manipulate any operating machinery immediately after taking Viagra.

What were the results obtained in clinical studies?

In a comparative study, evaluating the onset of penile rigidity in men with ED treated with Sildenafil Citrate and Tadalafil (Cialis), Viagra’s median time of action for the patients who obtained erections for sexual intercourse was 25 minutes with a range of 12-37 minutes.9
In a separate study, Viagra was still able to produce an erection in response to sexual stimulation 4-5 hours post administration.
Viagra proved effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy.

 

Important drug interactions with sildenafil

Sildenafil should not be used in combination with nitrates or nitric oxide donors as an unsafe drop in systemic blood pressure may occur.
Caution should be used if sildenafil is to be used in combination with either alcohol or anti-hypertension or blood-pressure-lowering medications.
Sildenafil is broken down predominantly by an enzyme called CYP3A in the liver; therefore, important interactions may occur with medications that affect this enzyme pathway.
Simultaneous use of bosentan and sildenafil may result in increased bosentan blood levels and decreased sildenafil blood levels. It is not known if these changes are clinically significant. Although a drug interaction has been demonstrated with sildenafil and bosentan, dose adjustments are presently not recommended for either drug.
Patients with human immunodeficiency virus (HIV or AIDS) who are taking medicines called antiretroviral agents should not use a phosphodiesterase inhibitor such as sildenafil since it can dramatically impair the efficacy of the antiretroviral.
Use of sildenafil with epoprostenol may reduce the blood level of sildenafil.
Use of sildenafil with beta blockers (another type of heart or blood pressure medicine) may increase the levels of sildenafil.

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Viagra Connect

Viagra Connect is a form of Viagra approved to be sold over the counter in Great Britain starting November 2017.
Viagra Connect is not intended for men with severe cardiovascular disorders or at high cardiovascular risk, or to patients with liver failure or taking certain interacting medicines.
Dr David Edwards, a GP with a special interest in sexual dysfunction and a past president of the British Society of Sexual Medicine, said: “In my clinical experience a man’s ability to attain and maintain an erection is of paramount importance to him.”
The Medicines and Healthcare Products Regulatory Agency from UK (MHRA), said it hopes that being able to buy Viagra without prescription will stop men seeking to buy it from unregulated websites. Rick Foy, the MHRA’s group manager in vigilance and risk management of medicines, said: “Erectile dysfunction can be a debilitating condition, so it’s important men feel they have fast access to quality and legitimate care and do not feel they need to turn to counterfeit online supplies which could have potentially serious side-effects.”

 

Take home messages

ED is more common than you might think, with 4.3 million men in the UK affected.
The couples affected by ED should seek medical advice and should try to prevent and treat this condition.
Sildenafil – the active ingredient in Viagra and Viagra Connect – has been available for over 20 years on the market, but as a prescription-only medicine.
Viagra Connect is the first medicine available in the UK without a prescription to help men with erectile dysfunction (ED).
Both Viagra and Viagra Connect are available to buy from the pharmacy and registered online pharmacies.
Viagra normally starts to work in 30 to 60 minutes, so you can be ready when you need to be.

 

First-time user?

Viagra will not enlarge the penis, and neither won’t decrease premature ejaculation.
Viagra does not protect against sexually transmitted diseases, including HIV.
Viagra is aimed to treat erectile dysfunction (ED) in men and it cannot be used in women.
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate medical advice as soon as possible.
Viagra can help a man get and keep an erection when he becomes sexually stimulated. It’s not right for everyone.
Viagra cannot stimulate a man’s imagination, but it can make him last longer in bed, it will allow a firmer erection with less stimulation and will make possible a few more erection during the interval of 4-5 hours postdose.
Your doctor may ask you to monitor your blood pressure on a regular basis particularly during your first few days on treatment or with a dose increase. Blood pressure monitoring is not needed for most patients.
If you experience any of the symptoms mentioned in the previous section, you should promptly notify your physician.
Also, follow up with a physician regarding the treatment with Viagra is recommended within six months of first being supplied the product.

 

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References:

  1. Virag R, Zwang G, Dermange H, Legman M. Vasculogenic impotence: a review of 92 cases with 54 surgical operations. Vasc Surg. 1981;15:9–17
  2. https://www.drugs.com/slideshow/viagra-little-blue-pill-1043;
  3. Yafi FA, Sharlip ID, Becher EF. Update on the Safety of Phosphodiesterase Type5 Inhibitors for the Treatment of Erectile Dysfunction. Sex Med Rev. 2018 Apr;6(2):242-252. doi: 10.1016/j.sxmr.2017.08.001. Epub 2017 Oct 12. Review. PubMed PMID: 28923561.
  4. http://www.foxnews.com/story/2008/03/24/discovered-by-accident-viagra-still-popular-10-years-later.html
  5. Redfield MM, Chen HH, Borlaug BA, et al. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA 2013;309:1268–77.
  6. Guazzi M, Samaja M, Arena R, Vicenzi M, Guazzi MD. Long-term use of sildenafil in
  7. https://www.viagra.com/learning/what-are-possible-side-effects
  8. http://www.ema.europa.eu/Viagra- Summary of product characteristics;
  9. https://clinicaltrials.gov/ A Randomized, Open-Label, Crossover, Multicenter, Single Dose Comparator Study Evaluating Onset Of Penile Rigidity In Men With Erectile Dysfunction Who Are Treated With Sildenafil And Tadalafil.

 

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